Mental health under fire: is parity of esteem enough?

The pips of the Today programme one day last month were followed by the bleak headline that a leading psychiatrist considers England’s mental health services to be in crisis. The minister for care services, Norman Lamb, has called the current situation “unacceptable”.

The investigation by the BBC and Community Care magazine that prompted these comments comes almost exactly two years since this coalition government published No Health, Without Mental Health, a paper which promised to give mental health “parity of esteem” with physical health. The service certainly does not have parity of esteem yet. Will it ever? We believe something more radical may be needed.

‘The idea of giving mental health parity of esteem with physical health is admirable’

Today’s investigation found that 1,711 mental health beds have been closed since April 2011, including 277 between April and August 2013. This represents a 9 per cent reduction in the total number of mental health beds available in 2011-12.

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When asked to comment on the findings, Mr Lamb claimed: “There is an institutional bias in the NHS against mental health and I am determined to end this.”

Need to get the balance right

Dr Geraldine Strathdee, NHS England’s national clinical director for mental health, emphasised the need “to get the right balance” of people being cared for in hospital and at home. However, for those on the front line of service delivery, such as Dr Martin Baggaley, medical director of South London and Maudsley Foundation Trust, their time seems to be taken up by battling to find beds for patients rather than focusing on treatment.

In 2010, the government programme Improving Access to Psychological Therapies (IAPT) was expanded to include treatment for depression and anxiety for adults of all ages, not just those of working age as had been the original intention. In 2011, NHWMH expanded IAPT’s focus even further. As the policy attempted to increase access to therapies such as cognitive behavioural therapy, the services available came under huge strain as those who had previously received no help were referred.

The Community Care and BBC investigation was concerned primarily with patients in crisis who require admission to psychiatric wards. Indeed, HSJ published similar findings only weeks earlier, reporting that at two points in August this year no beds were available in the London region at all. This is the more specialised end of mental health, with the patient usually having a history of difficulty. However, as Mr Lamb claims, if there is an “institutional bias” in the NHS against mental health then this is likely to exacerbate an already dire situation and have a knock-on effect on other, less specialised services, such as IAPT, as the service tries to cope with the overflow of patients who can’t be admitted.

The idea of giving mental health parity of esteem with physical health is admirable. However, as more research is beginning to demonstrate and most people can agree with anecdotally, if a patient has good mental wellbeing their recovery is often quicker and longer lasting. This is demonstrated by the National Institute for Health and Care Excellence’s recommendation to the NHS and doctors to prescribe mindfulness based cognitive therapy for recurrent depression in 2004.

No excuse for failure

Perhaps instead of aiming for the middle by attempting parity of esteem, the Department of Health and NHS England should be seeking to put mental health at the heart of all care. The NHS reorganisation cannot be allowed to excuse the failure to make provision for adequate mental health services, which have so often been the Cinderella of the health services. It should be the starting point for long term recovery, not a convenient add-on when considered cost effective.

‘Mental health should be the starting point for long term recovery, not a convenient add-on when considered cost effective’

The next 18 months will see all the political parties crank into electioneering mode. New policy will be developed but held back for key points in the process to garner the most electoral advantage. Labour is pushing forward its concept of whole person care, which so far has been more focused on elderly and social care.

Perhaps this investigation will ensure all three parties focus their health policy development on mental healthcare as the lynchpin to all health and wellbeing and truly secure the idea that there is no health, without mental health.

Jennifer White is senior consultant at Lexington Health